Current Client Authorization

If requested by Barbara Massey M.A. LMFT, this Authorization is for your care.

1. Place your name on the line of "Name of individual/client".
2. On the To line please place the name of the person this specific Authorization is intended for e.g., physician, spouse or other person coordinating care such as acupuncturist etc.
3. Initial on the lines that say "Mental health information" and "Drug/alcohol diagnosis, treatment, or referral information". (This information is especially protected by law.)

Authorizaton Form